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Constantinescu S, Niculescu AG, Hudiță A, Grumezescu V, Rădulescu D, Bîrcă AC, Irimiciuc SA, Gherasim O, Holban AM, Gălățeanu B, Oprea OC, Ficai A, Vasile BȘ, Grumezescu AM, Bolocan A, Rădulescu R. Silver/Graphene Oxide Nanostructured Coatings for Modulating the Microbial Susceptibility of Fixation Devices Used in Knee Surgery. Int J Mol Sci 2023; 25:246. [PMID: 38203420 PMCID: PMC10779033 DOI: 10.3390/ijms25010246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Exploring silver-based and carbon-based nanomaterials' excellent intrinsic antipathogenic effects represents an attractive alternative for fabricating anti-infective formulations. Using chemical synthesis protocols, stearate-conjugated silver (Ag@C18) nanoparticles and graphene oxide nanosheets (nGOs) were herein obtained and investigated in terms of composition and microstructure. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) characterizations revealed the formation of nanomaterials with desirable physical properties, while X-ray diffraction (XRD) analyses confirmed the high purity of synthesized nanomaterials. Further, laser-processed Ag@C18-nGO coatings were developed, optimized, and evaluated in terms of biological and microbiological outcomes. The highly biocompatible Ag@C18-nGO nanostructured coatings proved suitable candidates for the local modulation of biofilm-associated periprosthetic infections.
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Affiliation(s)
- Sorin Constantinescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari St. 8, 050474 Bucharest, Romania; (S.C.); (D.R.); (A.B.); (R.R.)
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania; (A.-G.N.); (A.M.H.)
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, Gh. Polizu St. 1-7, 060042 Bucharest, Romania; (A.C.B.); (A.F.); (B.Ș.V.)
| | - Ariana Hudiță
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania; (A.-G.N.); (A.M.H.)
- Department of Biochemistry and Molecular Biology, University of Bucharest, 050095 Bucharest, Romania;
| | - Valentina Grumezescu
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor St., 077125 Magurele, Romania; (V.G.); (S.A.I.); (O.G.)
| | - Dragoș Rădulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari St. 8, 050474 Bucharest, Romania; (S.C.); (D.R.); (A.B.); (R.R.)
| | - Alexandra Cătălina Bîrcă
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, Gh. Polizu St. 1-7, 060042 Bucharest, Romania; (A.C.B.); (A.F.); (B.Ș.V.)
| | - Stefan Andrei Irimiciuc
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor St., 077125 Magurele, Romania; (V.G.); (S.A.I.); (O.G.)
| | - Oana Gherasim
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor St., 077125 Magurele, Romania; (V.G.); (S.A.I.); (O.G.)
| | - Alina Maria Holban
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania; (A.-G.N.); (A.M.H.)
- Microbiology and Immunology Department, Faculty of Biology, University of Bucharest, 1-3 Portocalelor Lane, District 5, 77206 Bucharest, Romania
| | - Bianca Gălățeanu
- Department of Biochemistry and Molecular Biology, University of Bucharest, 050095 Bucharest, Romania;
| | - Ovidiu Cristian Oprea
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania;
- Academy of Romanian Scientists, Spl. Independenței 54, 50085 Bucharest, Romania
| | - Anton Ficai
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, Gh. Polizu St. 1-7, 060042 Bucharest, Romania; (A.C.B.); (A.F.); (B.Ș.V.)
- Academy of Romanian Scientists, Spl. Independenței 54, 50085 Bucharest, Romania
| | - Bogdan Ștefan Vasile
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, Gh. Polizu St. 1-7, 060042 Bucharest, Romania; (A.C.B.); (A.F.); (B.Ș.V.)
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania; (A.-G.N.); (A.M.H.)
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, Gh. Polizu St. 1-7, 060042 Bucharest, Romania; (A.C.B.); (A.F.); (B.Ș.V.)
- Academy of Romanian Scientists, Spl. Independenței 54, 50085 Bucharest, Romania
| | - Alexandra Bolocan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari St. 8, 050474 Bucharest, Romania; (S.C.); (D.R.); (A.B.); (R.R.)
| | - Radu Rădulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari St. 8, 050474 Bucharest, Romania; (S.C.); (D.R.); (A.B.); (R.R.)
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Leão RV, De Souza TRC, Helito PVP, Correa MFDP, Helito CP. Iliotibial band reconstruction with allograft fasciae latae tissue: Imaging aspects of a novel surgical technique. Radiol Case Rep 2023; 18:556-562. [DOI: 10.1016/j.radcr.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
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Dos Santos A, Gerometta A, Bohu Y, Lefevre N, Van Hille W, Khiami F, Hardy A. Anterior cruciate ligament arthroscopic reconstruction and lateral tenodesis with iliotibial band and gracilis tendon: Technical note. Orthop Traumatol Surg Res 2022; 108:103412. [PMID: 36150588 DOI: 10.1016/j.otsr.2022.103412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
While anterior cruciate ligament reconstruction using the iliotibial band is not a new technique, it still remains underdeveloped. The iliotibial band has historically been described as a thin and less resistant structure. Its harvesting has been associated with a risk of complications (hematoma, muscle hernia) and its small graft diameter increases the risk of rerupture. The addition of the gracilis tendon could potentially produce a graft with an increased diameter. In this technical note, we present a modification to the traditional technique performed on 50 patients, describing the surgical steps, graft diameter, clinical outcomes and complications at the 2-year follow-up. The mean graft diameter was 8.9±0.9 mm at the femur and 7.7±0.7 mm at the tibia. No rerupture was reported at the 2-year follow-up. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Alexandre Dos Santos
- Service de chirurgie orthopédique, CHU de Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | | | - Yoann Bohu
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - Nicolas Lefevre
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France
| | - William Van Hille
- Hôpital Privé La Châtaigneraie, 59, rue de la châtaigneraie, 63110 Beaumont, France
| | - Frédéric Khiami
- Service de chirurgie orthopédique, CHU de Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - Alexandre Hardy
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
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Rouf S, Malik A, Raina A, Irfan Ul Haq M, Naveed N, Zolfagharian A, Bodaghi M. Functionally graded additive manufacturing for orthopedic applications. J Orthop 2022; 33:70-80. [PMID: 35874041 PMCID: PMC9304666 DOI: 10.1016/j.jor.2022.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/22/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Additive Manufacturing due to its benefits in developing parts with complex geometries and shapes, has evolved as an alternate manufacturing process to develop implants with desired properties. The structure of human bones being anisotropic in nature is biologically functionally graded i,e. The structure possesses different properties in different directions. Therefore, various orthopedic implants such as knee, hip and other bone plates, if functionally graded can perform better. In this context, the development of functionally graded (FG) parts for orthopedic application with tailored anisotropic properties has become easier through the use of additive manufacturing (AM). Objectives and Rationale: The current paper aims to study the various aspects of additively manufactured FG parts for orthopedic applications. It presents the details of various orthopedic implants such as knee, hip and other bone plates in a structured manner. A systematic literature review is conducted to study the various material and functional aspects of functionally graded parts for orthopedic applications. A section is also dedicated to discuss the mechanical properties of functionally graded parts. Conclusion The literature revealed that additive manufacturing can provide lot of opportunities for development of functionally graded orthopedic implants with improved properties and durability. Further, the effect of various FG parameters on the mechanical behavior of these implants needs to be studied in detail. Also, with the advent of various AM technologies, the functional grading can be achieved by various means e.g. density, porosity, microstructure, composition, etc. By varying the AM parameters. However, the current limitations of cost and material biocompatibility prevent the widespread exploitation of AM technologies for various orthopedic applications.
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Affiliation(s)
- Saquib Rouf
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Abrar Malik
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Ankush Raina
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Mir Irfan Ul Haq
- School of Mechanical Engineering, Shri Mata Vaishno Devi University, J&K, India
| | - Nida Naveed
- Faculty of Technology, University of Sunderland, UK
| | | | - Mahdi Bodaghi
- School of Science and Technology, Nottingham Trent University, UK
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Wahed SB, Dunstan CR, Boughton PA, Ruys AJ, Faisal SN, Wahed TB, Salahuddin B, Cheng X, Zhou Y, Wang CH, Islam MS, Aziz S. Functional Ultra-High Molecular Weight Polyethylene Composites for Ligament Reconstructions and Their Targeted Applications in the Restoration of the Anterior Cruciate Ligament. Polymers (Basel) 2022; 14:polym14112189. [PMID: 35683861 PMCID: PMC9182730 DOI: 10.3390/polym14112189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
The selection of biomaterials as biomedical implants is a significant challenge. Ultra-high molecular weight polyethylene (UHMWPE) and composites of such kind have been extensively used in medical implants, notably in the bearings of the hip, knee, and other joint prostheses, owing to its biocompatibility and high wear resistance. For the Anterior Cruciate Ligament (ACL) graft, synthetic UHMWPE is an ideal candidate due to its biocompatibility and extremely high tensile strength. However, significant problems are observed in UHMWPE based implants, such as wear debris and oxidative degradation. To resolve the issue of wear and to enhance the life of UHMWPE as an implant, in recent years, this field has witnessed numerous innovative methodologies such as biofunctionalization or high temperature melting of UHMWPE to enhance its toughness and strength. The surface functionalization/modification/treatment of UHMWPE is very challenging as it requires optimizing many variables, such as surface tension and wettability, active functional groups on the surface, irradiation, and protein immobilization to successfully improve the mechanical properties of UHMWPE and reduce or eliminate the wear or osteolysis of the UHMWPE implant. Despite these difficulties, several surface roughening, functionalization, and irradiation processing technologies have been developed and applied in the recent past. The basic research and direct industrial applications of such material improvement technology are very significant, as evidenced by the significant number of published papers and patents. However, the available literature on research methodology and techniques related to material property enhancement and protection from wear of UHMWPE is disseminated, and there is a lack of a comprehensive source for the research community to access information on the subject matter. Here we provide an overview of recent developments and core challenges in the surface modification/functionalization/irradiation of UHMWPE and apply these findings to the case study of UHMWPE for ACL repair.
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Affiliation(s)
- Sonia B. Wahed
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
- Correspondence: (S.B.W.); (S.A.)
| | - Colin R. Dunstan
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Philip A. Boughton
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Andrew J. Ruys
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
| | - Shaikh N. Faisal
- ARC Centre of Excellence for Electromaterials Science & Intelligent Polymer Research Institute, Australian Institute of Innovative Materials, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Tania B. Wahed
- Department of Pharmacy, Jahangirnagar University, Savar 1342, Bangladesh;
| | - Bidita Salahuddin
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Xinying Cheng
- School of Biomedical Engineering, University of Sydney, Sydney, NSW 2006, Australia; (C.R.D.); (P.A.B.); (A.J.R.); (X.C.)
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Yang Zhou
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Chun H. Wang
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Mohammad S. Islam
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia; (Y.Z.); (C.H.W.); (M.S.I.)
| | - Shazed Aziz
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia;
- Correspondence: (S.B.W.); (S.A.)
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Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model. J Orthop Surg Res 2022; 17:7. [PMID: 34986843 PMCID: PMC8729105 DOI: 10.1186/s13018-021-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. METHODS A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. RESULTS AND DISCUSSION Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. CONCLUSION This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.
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Sun T, Zhang H. Biomechanical Comparison of a Novel Tibial Fixation Technique Versus Interference Screw Fixation for ACL Reconstruction Using Soft Tissue Grafts. Orthop J Sports Med 2021; 9:23259671211028559. [PMID: 34458385 PMCID: PMC8392818 DOI: 10.1177/23259671211028559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Controversy remains regarding the optimal technique for tibial fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis: To compare the biomechanical outcomes of a novel transtibial tubercle fixation technique with those of a commonly utilized interference screw fixation at the tibial site. Our hypothesis was that transtibial tubercle fixation achieves higher ultimate failure loads than interference screw fixation. Study Design: Controlled laboratory study. Methods: We used 24 matched porcine tibias and digital extensor tendons, from which 12 grafts and tibial tunnels were prepared using the novel transtibial tubercle fixation technique and 12 were prepared using the interference screw fixation technique. The specimens underwent a cyclic loading test (50-250 N applied for 1000 cycles at a frequency of 1 Hz), followed by a load-to-failure test. The slippage, stiffness, and ultimate failure loads were compared between the techniques. Results: No differences in slippage were found during the cyclic loading test, and no graft fixation or tibial complex failures occurred during cyclic testing in either group. The transtibial tubercle fixation technique had higher ultimate failure loads (mean ± SD, 756.28 ± 123.43 N) as compared with interference screw fixation (602.15 ± 81.62 N; P < .05). The grafts in the transtibial tubercle fixation group were less stiff than those in the interference screw fixation group (84.43 vs 101.23 N/mm; P < .05). Conclusion: Transtibial tubercle fixation achieved higher ultimate failure loads than interference screw fixation in the load-to-failure test. Clinical Relevance: The novel transtibial tubercle fixation technique compared favorably with interference screw fixation during ACL reconstruction. This technique does not require hardware, has a low cost, theoretically eliminates the risk of complications associated with hardware implantation (eg, graft damage and pain attributed to retained hardware requiring removal), and is relatively easy to perform.
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Affiliation(s)
| | - Hangzhou Zhang
- Department of Orthopedics, Joint Surgery and Sports Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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Zhao J. Single-Bundle Anatomical Hardware-Free Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2021; 10:e1609-e1613. [PMID: 34258211 PMCID: PMC8252817 DOI: 10.1016/j.eats.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 02/03/2023] Open
Abstract
In anterior cruciate ligament (ACL) reconstruction, fixation of the graft with hardware is a routine procedure. However, in some cases when the hardware is not intended to be used or is unavailable, ACL reconstruction with hardware-free fixation must be the treatment of choice. We introduce a single-bundle anatomical hardware-free ACL reconstruction technique in which a set of Y-shaped femoral tunnels is created for the fixation of the proximal end of the graft over the bone bridge between the 2 outer orifices, and a transtibial ridge tunnel is created to set a suture loop with a knot for the fixation of the distal end of the graft at the suture loop. We believe the introduction of this technique will provide a reasonable option for single-bundle anatomical ACL reconstruction.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China.
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Pereira VL, Medeiros JV, Nunes GRS, de Oliveira GT, Nicolini AP. Tibial-graft fixation methods on anterior cruciate ligament reconstructions: a literature review. Knee Surg Relat Res 2021; 33:7. [PMID: 33648610 PMCID: PMC7923495 DOI: 10.1186/s43019-021-00089-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/08/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction Anterior cruciate ligament (ACL) reconstruction is the most performed orthopedic surgical procedure. The result of ACL reconstructions depends on multiple technical variables, including tension to be applied to the graft for fixation, knee-flexion angle during fixation and the type of fixation to the bone. Objective To carry out a survey of the literature with the best evidence on these themes. Methods Literature review about methods of tibial-graft fixation in ACL reconstructions – tension applied at the time of fixation, type of graft fixation, and knee-flexion degree during tibial fixation. Results Thirty studies on the selected topics were found. Most studies point to graft-tension levels close to 90 N to obtain the best results. Regarding the knee-flexion angle, multiple studies suggest that fixation at a 30° angle would bring superior biomechanical advantages. Regarding the type of implant for fixation, it is not possible to affirm the superiority of one method over another in clinical outcomes. Conclusions There is no consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension, type of implant and knee-flexion angle. However, the analysis of the studies pointed to certain trends and allowed the drawing of specific conclusions.
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Affiliation(s)
- Vitor Luis Pereira
- Traumatology Sports Center (CETE) - (DOT-UNIFESP/EPM) - Orthopedics and Traumatology Department of the Escola Paulista de Medicina, Federal University of São Paulo, Säo Paolo, Brazil.
| | - João Victor Medeiros
- Resident in the Orthopedics and Traumatology Program, Orthopedics and Traumatology Department of the Escola Paulista de Medicina, Federal University of São Paulo, Säo Paolo, Brazil
| | - Gilvan Rodrigues Silva Nunes
- Resident in the Orthopedics and Traumatology Program, Orthopedics and Traumatology Department of the Escola Paulista de Medicina, Federal University of São Paulo, Säo Paolo, Brazil
| | - Gabriel Taniguti de Oliveira
- Traumatology Sports Center (CETE) - (DOT-UNIFESP/EPM) - Orthopedics and Traumatology Department of the Escola Paulista de Medicina, Federal University of São Paulo, Säo Paolo, Brazil
| | - Alexandre Pedro Nicolini
- Traumatology Sports Center (CETE) - (DOT-UNIFESP/EPM) - Orthopedics and Traumatology Department of the Escola Paulista de Medicina, Federal University of São Paulo, Säo Paolo, Brazil
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ABIDIN NURAFIKAHZAINAL, KADIR MOHAMMEDRAFIQABDUL, RAMLEE MUHAMMADHANIF. BIOMECHANICAL EFFECTS OF DIFFERENT LENGTHS OF CROSS-PINS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A FINITE ELEMENT ANALYSIS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Complication rates of anterior cruciate ligament reconstruction (ACL-R) were reported to be around 15%. Although it is a very common arthroscopic surgery with good outcomes, breakage and migration of fixators are still possible to occur due to stability issue. One of the factors that affects the mechanical stability of fixators is its length. Therefore, the aim of this paper is to analyze the biomechanical effects of different lengths of fixators (cross-pin technique) towards the stabilities of the knee joint after ACL-R. Finite element analyses of knee joint with DST grafts and fixators were carried out. Mimics and 3-Matic were used in the development of knee joint models, while the grafts and fixators were designed by using SolidWorks software. All models were remeshed in the 3-Matic and numerical analysis was performed via MSC.Marc Mentat software. A 100 N anterior tibial load was applied onto the tibia to simulate the anterior drawer test after the surgery and proximal femur was fixed at all degrees of freedom. Based on the findings, cross-pin with 40[Formula: see text]mm in length provided the most favorable option for better treatment of ACL-R, where it could promote osseointegration and preventing fracture.
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Affiliation(s)
- NUR AFIKAH ZAINAL ABIDIN
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - MOHAMMED RAFIQ ABDUL KADIR
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
| | - MUHAMMAD HANIF RAMLEE
- Medical Devices & Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
- Bioinspired Devices and Tissue Engineering Group (BIOINSPIRA), Faculty of Engineering, School of Biomedical Engineering and Health Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
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Bianchi S, Fischer B, Pruès-Latour V, Wyssa B. Ultrasound Appearances of Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:169-179. [PMID: 31232482 DOI: 10.1002/jum.15077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
Anterior cruciate ligament tears are among the most frequent knee injuries. Surgical treatment is mandatory in active athletes to prevent meniscal tears and early joint degenerative changes. Anterior cruciate ligament arthroscopic reconstruction (ACLAR) is considered the preferred procedure, allowing a successful functional restoration and a prompt return to sports practice. Postsurgical complications are infrequent and are mainly assessed clinically and by magnetic resonance imaging. Although ultrasound can only evaluate the outer aspect of the knee, it can detect several ACLAR complications. The aim of this pictorial essay is to present the ultrasound appearances of a wide spectrum of ACLAR complications.
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Gobbi A, Whyte GP. Long-term Outcomes of Primary Repair of the Anterior Cruciate Ligament Combined With Biologic Healing Augmentation to Treat Incomplete Tears. Am J Sports Med 2018; 46:3368-3377. [PMID: 30398894 DOI: 10.1177/0363546518805740] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment to repair partial anterior cruciate ligament (ACL) injury without reconstruction has demonstrated inconsistent clinical success. PURPOSE To examine the long-term clinical outcomes of primary ACL repair combined with biologic healing augmentation in patients with symptomatic partial ACL tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS 50 patients (mean age, 29.5 years) with a partial ACL tear and symptomatic knee instability were treated with primary ligament repair in conjunction with marrow stimulation and followed prospectively for a mean duration of 10.2 years (range, 5.3-14.3 years). Comparative analysis of preinjury, preoperative, and postoperative scores using patient-reported assessment instruments was performed to examine clinical outcomes. Correlation of final outcome scores with patient age, type of ACL tear, side-to-side difference in ligamentous laxity, and body mass index (BMI) was performed through use of Spearman rank analysis. RESULTS 44 patients were available for assessment at final follow-up. The median Tegner Activity Scale score of 7 at final follow-up was the same as the preinjury median score of 7 ( P = .128). The mean Marx Activity Scale, International Knee Documentation Committee (IKDC) Subjective, and Lysholm Knee Questionnaire scores were 10.8, 90.4, and 96.2, respectively, at final follow-up. Mean final Knee injury and Osteoarthritis Outcome Score (KOOS) subset assessments of Pain, Symptoms, Activities of Daily Living, Sports, and Quality of Life were 98.6, 97.5, 99.7, 94.3, and 95.6, respectively. Secondary ACL insufficiency occurred in 27% of patients. Clinical outcome scores were similar for all scoring instruments between patients treated for an associated diagnosis of meniscal or articular cartilage injury. No significant correlations of age, BMI, ACL tear type, or laxity and final IKDC Subjective, Lysholm, or KOOS scores were found. Analysis revealed a negative correlation of patient age and Tegner score at preinjury ( rs = -0.333, P = .022) and at final follow-up ( rs = -0.376, P = .013). The mean side-to-side difference in ligamentous laxity of 3.4 mm at short-term follow-up in those patients who developed secondary ACL insufficiency over the duration of follow-up was significantly greater than the mean of 0.9 mm in those who did not ( P = .010). CONCLUSION Primary ACL repair combined with biologic healing augmentation to treat select cases of knee instability secondary to incomplete ACL rupture demonstrated good to excellent long-term outcomes in this cohort for those patients who did not experience secondary ACL insufficiency, with high rates of restoration of knee stability and return to preinjury athletic activities. The rate of secondary treatment for recurrent ACL insufficiency over the course of long-term follow-up was greater than would be expected for primary ACL reconstruction. Greater side-to-side differences in objective findings of ligamentous laxity were identified at shorter term follow-up in the patients who later went on to experience symptomatic secondary ACL insufficiency, compared with those who maintained stability long term.
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Affiliation(s)
- Alberto Gobbi
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy
| | - Graeme P Whyte
- Orthopaedic Arthroscopic Surgery International (OASI) Bioresearch Foundation, Milan, Italy.,Cornell University, Weill Medical College, New York, NY, USA.,New York Presbyterian Hospital/Queens, Queens, New York, NY, USA
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Elena N, Woodall BM, Mirvish A, Brown CM, McGahan PJ, Pathare NP, Shin EC, Chen JL. The Tibial Tug Test: An Intraoperative Test to Assess Tibial Fixation During Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2018; 7:e853-e857. [PMID: 30167364 PMCID: PMC6112261 DOI: 10.1016/j.eats.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament (ACL) is commonly injured, especially in athletes performing twisting and pivoting motions. ACL reconstruction is a standard procedure; however, there is no way to intraoperatively assess one of the causes of failure: the lack of adequate graft fixation on the tibial side. Different fixation devices can be used to ensure fixation, but there is as yet no consensus on which is the most effective. Moreover, there is no reliable way to assess their strength in the intraoperative setting. The tibial tug test is meant to be an important resource to help avoid fixation failure by evaluating the tibial fixation device intraoperatively and giving the surgeon the opportunity to revise the tibial fixation if deemed inadequate. The aim of this article is to describe an empirical and simple test that can demonstrate to the surgeon adequate tibial fixation during ACL reconstruction surgery.
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Affiliation(s)
- Nicholas Elena
- Address correspondence to Nicholas Elena, M.D., Aosportsmed, 450 Sutter Street, Suite 400, San Francisco, CA 94108, U.S.A.
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